I’ve just had a natural miscarriage, why is my period so heavy?

As a society, we don’t talk much about miscarriage. For that reason, women often feel like they can’t share their experiences and often feel isolated and shameful when it does occur. Many will wonder if it happened because of something they did, or if they are the only person who has had one.

If you have experienced a miscarriage you can be sure that you are not alone, however much it may feel like it. In fact, spontaneous miscarriage is the most common complication of pregnancy, occurring in 15-20% of women known to be pregnant.1 So, the truth is 1 in 5 pregnant women will have a miscarriage.

There is no shame to be felt, and, while this will provide little comfort, it may help to know that it is a natural part of the reproductive cycle, a mechanism that our bodies have to halt pregnancies that may not develop normally. At the very least this knowledge will help inform you that what you have experienced isn’t something that is any way your own fault and many other women will have experienced the same or similar feelings to what you are experiencing.

Types of miscarriage and management

A miscarriage is the loss of a pregnancy during the first 23 weeks. A natural or spontaneous miscarriage is usually detected by a woman if she knows she is pregnant and subsequently develops moderate to heavy vaginal bleeding like a period. In other cases, a woman may be unaware she has miscarried until she has a scan and it is diagnosed.

Miscarriages that are diagnosed by a doctor are normally what is referred to as a ‘missed’ miscarriage, as the bleeding hasn’t started yet. Sometimes, if miscarriage is diagnosed via a scan you may either wait for your body to expel it, or have it surgically removed, depending on your circumstances.

Not all bleeding during early pregnancy means that you are having a miscarriage. Light bleeding is common during the first trimester and most women will usually attend an early pregnancy clinic if they develop spotting or bleeding, to confirm if the pregnancy is still viable. If the pregnancy is still inside the womb and a fetal heartbeat is seen, this is known as a threatened miscarriage. Threatened miscarriages can still develop into healthy pregnancies.

Any heavy bleeding during early pregnancy requires a scan to check if the pregnancy is still viable.

Any heavy bleeding during early pregnancy requires a scan to check if the pregnancy is still viable. It is also important in women with heavy bleeding to check if the pregnancy tissue is still inside the womb. If the pregnancy tissue is present inside the womb, the heartbeat is checked. Diagnosis of a miscarriage on a scan is based on an absent fetal heart beat. Some women don’t have any signs of bleeding, despite an absent fetal heartbeat.

After a miscarriage diagnosis, the pregnancy tissue will usually pass out naturally in the following one or two weeks. Waiting for the body to pass the tissue naturally is called expectant management. Sometimes, if two weeks have gone by, or if a woman prefers, medication is prescribed to help the cervix to open and to allow the womb to expel the pregnancy tissue. This is called medical management of miscarriage.

Furthermore, some women prefer to have surgical management, which involves going under anaesthesia to have the pregnancy tissue removed with a suction apparatus. Surgical management is also recommended if there is very heavy bleeding, the tissue is infected, or if expectant and medical management has not worked.

Miscarriage and heavy bleeding

If a miscarriage has happened spontaneously/naturally, or you have chosen expectant management, and have started to bleed, the bleeding can be quite heavy. The onset of bleeding usually occurs due to the drop in progesterone.2 Progesterone is the hormone that is required to thicken the lining of the uterus for successful implantation of an embryo. It is also required during the first trimester to support the pregnancy.

Bleeding varies based on the individual, and can range from light spotting to heavy bleeding with clots. The bleeding can come and go over several days. Pregnancy loss before six weeks gestation, and in women who have low human chorionic gonadotropin (HCG) levels (the pregnancy hormone), tend to have lighter bleeding, similar to a period.3

Bleeding and pain are usually highest during the first eight days from the start of bleeding. Once the tissue has been passed, which often looks like a big clot, the bleeding usually settles.

However, this is not always the case. Heavy bleeding tends to be more common the further into the pregnancy a woman is and occurs as the body has to expel the pregnancy tissue. The lining of the womb, which is quite thick during pregnancy and in contact with lots of blood vessels has to shed away. The pregnancy sac which contains the foetus also has to come out. Both of these contribute to the heavier bleeding seen during a miscarriage.

Bleeding and pain are usually highest during the first eight days from the start of bleeding.4 Once the tissue has been passed, which often looks like a big clot, the bleeding usually settles. In some cases, duration can be as long as 6-8 weeks.5 If bleeding lasts longer or if the bleeding is significantly affecting your quality of life during this time, then a trip to your doctor is warranted.

Bleeding that leads to a pad needing to be changed every hour is a reason to attend your local hospital so a doctor can assess you. In addition, if you feel dizzy, feel faint, the pain is unbearable or you feel generally unwell and feverish, then you should also attend your local hospital.

It is important to see a doctor if you are having a miscarriage and you also have a bleeding disorder or you are on blood thinning medication, as you can bleed more heavily than the average woman. In this case, expectant management (if a miscarriage was diagnosed by a scan), may not be offered.

If you develop bleeding, severe tummy pain, vomiting, diarrhoea and/or dizziness and you know you are pregnant but have not had a scan yet, attend your local hospital as soon as possible so they can rule out an ectopic pregnancy.

After a miscarriage

After the bleeding has stopped, a home pregnancy test is usually advised after three weeks to make sure all the tissue has passed. A positive pregnancy test can mean that some tissue may still be present in the womb, and so you may have to attend the early pregnancy unit again for a repeat scan, or go to your GP for a referral.

Whether you have had a natural, medical or surgical miscarriage, the time it takes for your periods to return to normal should be approximately 4-6 weeks.

Whether you have had a natural, medical or surgical miscarriage, the time it takes for your periods to return to normal should be approximately 4-6 weeks. However it is also dependent on how regular your cycles were prior to the miscarriage. If you have not had a period after six weeks and you usually have regular periods, then see your GP. It may take a few months to get back into a regular cycle. Your next period may be light, normal or heavy. All are normal occurrences.

There are no rules as to when you should try to get pregnant again, but it is best to wait until you have had one period after your miscarriage. A period means you are ovulating. If you are ovulating, you are fertile and able to try again. It is important to feel emotionally and mentally ready before trying again, and taking some time out to mourn your miscarriage is completely normal and can be therapeutic. Trying again soon after the miscarriage, if you feel ready, does not increase your risk of miscarrying again.

There are various support services available for women who have had a miscarriage. Your GP or practice nurse can point you in the right direction. Furthermore, talking about it with someone, be it friends, family, or in a support group can help you to realise how common miscarriages actually are.

Featured image shows a woman sitting on a bed, leaning forward and resting her elbows on her knees. The image is cropped so you can’t see her head.

Shreya is a London-based doctor specialising in Obstetrics and Gynaecology. Her passion in global and public health, family planning, and reproductive rights led her to pursue a masters in Public Health at Harvard. She is a strong believer that women should have easily accessible, accurate information about their health, to enable them to make decisions about their health that are right for them.